CC2: Anatomy and Physiology of the Liver

Liver

It is the chief metabolic organ in the body (the total of all chemical changes that takes place in a cell or an organism to produce energy and basic materials needed for important life processes).

1,500 ml (1.5 liters)

Liver receives _______ of blood per minute

1. Hepatocytes

2. Kupffer cells

2 types of cells in the liver?

Kupffer cells

It is a phagocytic cell in the liver that engulf foreign organism?

lobules

The cells are arrange into the ______, the anatomic unit of liver

Liver

It has a unique capacity to regenerate by cell division and hypertrophy of the remaining tissue in case of tissue injury due to biliary obstruction or toxic exposure?

excretion, detoxification and metabolic activity

Severe loss of hepatic functions of __________, __________ and ____________ that are reflected in multiple standard and specialized tests.

80%

To abolish liver tissue function, more than ________ of the liver must be destroyed.

Liver

- Site for protein synthesis

- Production of fibrinogen

- Destruction of worn out erythrocyte

- Center for fat and CHO metabolism

Cholelithiasis

Medical term for gallstone?

1. Synthetic function

2. Conjugation

3. Detoxification and drug metabolism

4. Excretory and secretory function

5. Storage function

What are the liver functions?

1. Plasma proteins

2. CHO

3. Lipids

4. Lipoproteins

5. Clotting factors

6. Ketone bodies

7. Enzymes

Synthetic function:

Give atleast 3 secretions by liver?

12 grams

Synthetic funtion:

Normal liver produces about ______ of albumin daily

digestive surfactants

Synthetic function:

Liver is involved in metabolism of cholesterol into bile acids potent "______________", emulsifiers

Conjugation

Involves in bilirubin metabolism?

200-300 mg

How many mg of bilirubin is produced daily in the healthy adults?

Bilirubin

A yellowish substance made during your body's normal process of breaking down old red blood cells?

Bile

Bilirubin is found in the?

Bile

It is a fluid that the liver made and helps digest food?

bilirubin

Conjugation:

Healthy liver will remove most of the _________ from the body

nitrogenous waste

Detoxification and drug metabolism:

One of the functions of liver is the detoxification of _______________

Liver

Detoxification and drug metabolism:

It serves to protect the body from potentially injurious substances absorbed from the intestinal tract and toxic by-products of metabolism.

urea

Detoxification and drug metabolism:

ammonia (toxic by-product) is converted to ______ in the liver

Excretory

Excretory and secretory function:

__________ of bile- bile acids and salts, pigments, cholesterol.

glycine and taurine

Excretory and secretory function:

cholic acid and chenodeoxycholic acid-bile acids are conjugated with the amino acid _______ and _______ forming bile salts.

Liver

glycogen

Storage function:

It is a storage site for all fat-soluble vitamins. It is also the storage depot for __________, which are released when glucose is depleted.

TEST MEASURING THE HEPATIC SYNTHETIC ABILITY

It is useful for quantitating the severity of hepatic dysfunction?

serum albumin and vit. K dependent

___________ and __________ coagulation factors provide the most useful indices for assessing severity of liver disease.

Protein analysis

Total protein determination:

It is important in assessing nutritional status and presence of severe diseases involving liver, kidney and bone marrow?

10% higher

Total protein determination:

total protein and albumin are about ____________ in ambulatory individuals

0.2-0.4 g/dl higher

Total protein determination:

plasma levels of total protein is _____________ than serum due to fibrinogen.

<3.0 g/dl

>3.0g/dl

Total protein determination:

transudate have TP of _________, while exudates _________

hemolysis

Total protein determination:

measuring TP in serum may not be required, ________ is forbidden (false +)

serum

Total protein determination:

What is the specimen of choice?

1. No anticoagulant

2. No fibrinogen

Total protein determination:

Why does serum is the specimen of choice?

6.5-8.3 g/dl

Total protein determination:

Reference values?

II, VII, IX and X

What are the vitamin K dependent?

Kjeldahl method

- standard ref. method, not commonly perform method

- it is based on measurement of nitrogen content

- it uses serum treated with tungstic acid forming protein free filtrate (PFF)

6.5 grams

1 gram of nitrogen is equal to _______ of proteins

15.1% - 16.8%

What is the percentage of nitrogen content proteins?

H2SO4 (sulfuric acid)

What is the reagent (digesting agent) used in kjeldahl method?

Ammonia

What is the end product in kjeldahl method?

Biuret Method

most widely use mtd. recommended by IFCC International Federation of Clinical

Chemist expert panel?

Biuret Method

- it is extensively used in clinical lab, particularly in automated analyzers in w/c protein concentration can be measured down to 10-15 mg/dl.

- requires atleast 2 peptide bonds and an alkaline medium

Biuret Method

violet-colored

Principle: cupric ions complex the groups involved in the peptide bond forming a __________________ chelate w/c is proportional to the number of peptide bonds present and reflects the total protein level at 545nm.

1. Alkaline copper sulfate

2. Rochelle salt (NaK Tartrate)

3. NaOH & Potassium Iodide

What are the reagents used in Biuret Method?

Follin-Ciocalteu (Lowry) Method

It has the highest analytical sensitivity?

deep blue color

Follin-Ciocalteu (Lowry) Method:

oxidation of phenolic compounds such as tyrosine, tryptophan and histidine. result is ______________

1. Phosphotungstic - molybdic acid

2. Phenol reagent

3. Biuret reagent

Reagents used in Follin-Ciocalteu (Lowry) Method?

Ultraviolet absorption method

proteins absorb light at 280nm and at 210nm?

tryptophan, tyrosine and phenylalanine

In ultraviolet absorption method, absorption at 280nm is due to ____________, ___________ and _____________.

Electrophoresis

Principle: Migration of charged particles in an electric field?

immunoglobulins

hypergammaglobulinemia

the single most clinical application of serum protein electrophoresis (SPE) is for the identification of monoclonal spikes of ________________ and differentiating them from polyclonal _______________________

TPAG (total protein, albumin and globulin)

What does refractometry measures?

1. Sulfosalicylic acid

2. Trichloroacetic acid

What are the protein precipitating agents used in Turbidimetric and Nephelometric?

Turbidimetric and Nephelometric

A method that precipitates with scattered light/incident light or blocked light?

Sodium sulfate

What salt is used for analysis (salting-out) in salt fractionation?

Albumin

It is soluble in water but insoluble in saturated salt solution?

Globulin

It is insoluble in water but soluble in weak salt solution?

1. Coomasie brilliant blue dyes

2. Ninhydrin

What are the 2 other measurements?

1. Malignancy Multiple Myeloma

2. Waldenstrom Macroglobulinemia

Conditions that increases total protein (TP)?

1. Hepatic cirrhosis (high alpha-fetoprotein)

2. Glumerulonephritis

3. Nephrotic syndrome

4. Starvation

Conditions that decreases total protein (TP)?

Prothrombin Time

- Differentiates intrahepatic disorder (prolonged Protime) from extrahepatic obstructive liver disease (normal Protime)

- Persistent prolongation of protime despite vi K administration indicates loss of hepatic capacity to synthesized the proteins

- Prolongation of Protime indicates massive cellular damage

inversely

The concentration of albumin is __________ proportional to the severity of the liver disease

1. BCG (most commonly used)

2. BCP (purple)

3. HABA (hydroxyazobenene benzoic acid

4. MO (Methyl orange) dyes

Give atleast two methods for testing albumin?

3.5-5.0 g/dl (35-50 g/L)

Reference value of albumin?

Albumin

In severe hepatocellular, mababa ang?

Hepatic cirrhosis

Low TP + Low Albumin = _________________

Hypoalbuminemia

denotes a disease process?

1. Chronic liver dse

2. Malabsorption syndrome

3. Malnutrition

4. Muscle waiting disease

Hypoalbuminemia:

Give atlease two conditions that reduced synthesis of albumin?

1. Nephrotic syndrome

2. Massive burns

3. Protein losing enteropathy

4. Orthostatic abuminuria

Hypoalbuminemia:

Give atlease two conditions that increase loss of albumin?

1. Massive burns

2. Widespread malignancy

3. Thyrotoxicosis

Hypoalbuminemia:

Give atlease two conditions that increase catabolism of albumin?

Globulin

Can be determined directly by colorimetric method using glyoxylic acid environment (acetic and sulfuric acids)?

Purple color

What is the positive color of globulin?

Globulin

Total protein - albumin = _____________

1.3:3.0

What is the reference value of albumin/globulin ratio?

Bilirubin

- End product of hemoglobin metabolism and the principal pigment of bile

- It is also formed from destruction of heme-containing proteins such as myoglobin, catalase and cytochrome oxidase

Direct bilirubin (conjugated)

is the form of bilirubin which has been conjugated with glucuronic acid and is excreted in the bile. Measurement of this metabolite is of assistance in diagnosis and monitoring of the many disease states associated with raised bilirubin?

Unconjugated or indirect bilirubin

A type of bilirubin that is bound to a certain protein (albumin)?

conjugated or direct bilirubin

In the liver, bilirubin is changed into a form that your body can get rid of. This is called?

1. Pre hapatic

2. Hepatic

3. Post hepatic

What are the 3 phases in bilirubin metabolism?

120 days

Life span of RBC?

(Drawing/Rewrite niyo nalang)

Discuss the Bilirubin Metabolism?

Jaundice

- Also known as icterus/hyperbilirubinemia

- Yellowish discoloration of the skin, sclerae and mucus membrane

2-3 mg/dL

Jaundice is clinically evident if the bilirubin exceeds _________

NV = 1-2mg/dL

Jaundice = 3-4mg/dL

Bilirubin:

NV = ?

Jaundice = ?

TB = 0.2 - 1.0 mg/dL

DB = 0 - 0.2 mg/dL

IB = 0.2 - 0.8 mg/dL

Normal value:

TB = ?

DB = ?

IB = ?

Pre-hepatic Jaundice

Classification of Jaundice/Hyperbilirubinemia:

Lab results:

IB - increased

DB - normal

Urobilinogen - normal

Urine bilirubin - negative

1. Too much production of RBC

2. Polycythemia vera

Causes of Pre-hepatic Jaundice?

Post-hepatic hyperbilirubinemia

Classification of Jaundice/Hyperbilirubinemia:

Lab results:

IB - normal

DB - increased

Urobilinogen - decreased

Urine Bilirubin - Positive

ALP - increased (Alkaline phosphatase)

Hepatocellular Combine Hyperbilirubinemia

Classification of Jaundice/Hyperbilirubinemia:

Lab results:

IB and DB - increased

Urobilinogen - decreased

Urine Bilirubin - positive

1. Gilbert's Syndrome

2. Crigler-Najjar Syndrome

3. Dubin-Johnson Syndrome

4. Lucey-Driscoll Syndrome

What are the four derangements of Bilirubin Metabolism/Hereditary forms (Syndromes)?

Gilbert's Syndrome

Derangements of Bilirubin Metabolism:

Bilirubin Transport Deficit?

20 to 30 years old

Gilbert syndrome is usually diagnosed during ____ to ____ years old

Crigler-Najjar Syndrome

Derangements of Bilirubin Metabolism:

Conjugation Deficit?

Type 1

What type of Crigler-Najjar Syndrome that is deficient in UDGP and B2 (walang na p'produce na B2)?

Type 2

What type of Crigler-Najjar Syndrome that is only produce a small amount of B2?

Dubin-Johnson Syndrome

Derangements of Bilirubin Metabolism:

Excretion Deficit?

Dubin-Johnson Syndrome

Derangements of Bilirubin Metabolism:

A blockage excretion of bilirubin due to hepatocyte membrane defect (elevated TB and B2)?

Lucey-Driscoll Syndrome

Derangements of Bilirubin Metabolism:

Conjugation Inhibitor?